Person: ONUR, ÖZGE ECMEL
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ONUR
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ÖZGE ECMEL
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Publication Open Access Electrocardiographic clue for a mid-LAD lesion(2016-03-17) ONUR, ÖZGE ECMEL; Ak, Rohat; Doganay, Fatih; Onur, Ozge Ozberk; Akoglu, Ebru UnalPublication Open Access Initial inferior vena cava and aorta diameter parameters measured by ultrasonography or computed tomography does not correlate with vital signs, hemorrhage or shock markers in trauma patients(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2017) DENİZBAŞI ALTINOK, ARZU; Celik, Omer Faruk; Akoglu, Haldun; Celik, Ali; Asadov, Ruslan; Onur, Ozge Ecmel; Denizbasi, ArzuBACKGROUND: Ultrasonography (US) is noninvasive, readily available, and cheap. The diameter of inferior vena cava (dIVC) and its respiratory variation were proposed as a good surrogate of the hemodynamic state. However, recent studies have shown conflicting results, and the value of IVC-derived parameters in the estimation of fluid status and hemorrhage remains unclear. METHODS: This was an observational study of trauma patients who presented to emergency department. dIVC and aorta diameter (dAorta) were measured at the initial US and CT in all patients. The correlation of these measurements and all parameters derived from those measurements along with the initial vital signs and laboratory values of hemorrhage (hemoglobin, hematocrit) and shock (lactate, base excess) were assessed. US and CT values were also compared for accuracy using Bland-Altman analysis. RESULTS: The final study population was 140, with a mean age of 38 years and 79.3% were male. dIVC and dAorta did not have any clinically significant correlation with any of the vital signs or laboratory values of hemorrhage or shock when measured by US or CT. A good and significant correlation was observed between dIVC and dAorta measured by US and CT. CONCLUSION: The value of an initial and single measurement of IVC and aorta parameters in the evaluation of trauma patients should be questioned. However, the change in the measured parameters may be of value and should be investigated in further studies.Publication Open Access Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?(SAGE PUBLICATIONS LTD, 2020-09) AKOĞLU, HALDUN; Rohat, Ak; Doganay, Fatih; Akoglu, Ebru Unal; Akoglu, Haldun; Ucar, Asli Bahar; Kurt, Erdem; Turan, Cansu Arslan; Onur, OzgeBackground: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation. Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis. Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted. Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores. Conclusion: The accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis scoring system was higher for the diagnosis of acute appendicitis than the other scores. The cut-off of the Raja Isteri Pengiran Anak Saleha Appendicitis score from a 7.5-point threshold provides a practical, non-invasive, rapid diagnostic method that increases acute appendicitis discriminative power in patients presenting with right lower quadrant pain.Publication Open Access Determination of Pro-BNP and Troponin I Levels for ShortTerm Mortality Prediction in Ischemic Stroke Patients who did not Undergo Revascularization(2022-01-01) ÖZPOLAT, ÇİĞDEM; ONUR, ÖZGE ECMEL; DENİZBAŞI ALTINOK, ARZU; AKOĞLU, HALDUN; Aydın N., Özpolat Ç., Onur Ö. E. , Akoğlu H., Denizbaşı Altınok A.Introduction: Emergency departments (EDs) are the first place to start treatment for most stroke patients. Prognozing patients for planning and proper management of the therapies have an important place in approaching stroke patients. Many studies have been carried out with serum biomarkers especially in terms of prognosis stroke. Our objective, in this study, is to research short-term (14th day) mortality prediction of serum Troponin I (TnI) and pro-brain natriuretic peptide (BNP) levels. Methods: This was a prospective and observational prognostic test study. All consecutive patients admitted to the ED with the onset of symptoms in the past 24 h and diagnosed with the first episode of acute ischemic stroke were included in the study. A total of 121 subjects were included in the study. On admission, pro-BNP and TnI were collected from all subjects. On the 14th day of admission, patients were checked for mortality. Results: Of 121 patients, 14 (11.5%) had a mortal outcome at the end of the 14th day. The overall median pro-BNP level of all patients was 799.00 pg/ml (IQR: 220.00–2818.25). The median pro-BNP level of the non-survivor group was significantly higher than that of the survivor group (p:0.030). However, there was no significant difference between the TnI levels of the mortality groups. The optimal cutoff value of serum pro-BNP levels as an indicator of mortality on the 14th day was estimated to be 509 pg/ml (sensitivity: 85.7%, specificity: 49.5%, and AUC: 0.68 [95% CI, 0.59–0.769]). Discussion and Conclusion: Various biomarkers are investigated for prediction of mortality in ischemic stroke patient. According to our study, elevated pro-BNP values are associated with mortality. Further study with larger patient cohorts can be studied regarding the relationship between these threshold, in terms of predicting the mortality, in a more comprehensive study, as well as using subgroup and underlying conditions.Publication Open Access Diagnostic Accuracy of the Electrocardiography Criteria for Left Ventricular Hypertrophy (Cornell Voltage Criteria, Sokolow-Lyon Index, Romhilt-Estes, and Peguero-Lo Presti Criteria) Compared to Transthoracic Echocardiography(CUREUS INC, 2021-03-14) DENİZBAŞI ALTINOK, ARZU; Bayram, Nurseli; Akoglu, Haldun; Sanri, Erkman; Karacabey, Sinan; Efeoglu, Melis; Onur, Ozge; Denizbasi, ArzuObjective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (>= 130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.Publication Open Access Diagnostic accuracy of the ECG criteria for left ventricular hypertrophy (cornell voltage criteria, sokolow-lyon index, romhilt-estes, and peguero-lo presti criteria) compared to transthoracic echocardiography(2021-03-01) AKOĞLU, HALDUN; ONUR, ÖZGE ECMEL; KARACABEY, SİNAN; EFEOĞLU, MELİS; DENİZBAŞI ALTINOK, ARZU; Akoğlu H., Onur Ö. E., Karacabey S., Efeoğlu Saçak M., Denizbaşı Altınok A.Objective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], RomhiltEstes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.Publication Open Access An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey(KARE PUBL, 2020) DENİZBAŞI ALTINOK, ARZU; Sacak, Melis Efeoglu; Akoglu, Haldun; Onur, Ozge; Altinok, Arzu DenizbasiOBJECTIVE: One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital's ED. METHODS: This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017. RESULTS: A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (+/- SD) age was 32.2 (+/- 12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively. CONCLUSION: We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.Publication Open Access Comparison of the predictive utility of Revised Trauma Score, Emergency Trauma Score, and Glasgow Coma Scale-Age-Pressure scores for emergency department mortality in multiple trauma patients(MARMARA UNIV, FAC MEDICINE, 2020-10-23) DENİZBAŞI ALTINOK, ARZU; Efeoglu Sacak, Melis; Akoglu, Haldun; Onur, Ozge; Denizbasi, ArzuObjective: In this study, we aimed to compare the utility of Revised Trauma Score (RTS), Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scores, and Emergency Trauma Score (EMTRAS) in multiple trauma patients for the prediction of mortality in the emergency department (ED). Materials and Methods: In this observational diagnostic accuracy study, a consecutive convenience sample of all adult patients (older than 16 years) with multiple trauma (injuries confined to at least two body regions) admitted to the trauma bay of the ED during the shifts of the researchers was used. Presence of ED mortality was recorded, and RTS, EMTRAS, and GAP scores were calculated at the analysis stage of this study. Results: The study sample included 279 multiple trauma patients. Of the 279 patients, 13 (4.7%) died in the ED. Among the 266 patients who survived to hospital admission, 3 were lost to-follow-up (foreigner patients). In the following 30 days, 28 more patients were lost, 23 in the Intensive Care Unit (ICU) (23/62, 37.1%), 4 in the wards (4/131, 3.1%), and 1 after discharge (1/73, 0.1%). The prognostic accuracies (AUC) of RTS, EMTRAS, and GAP were 0.92, 0.94, and 0.93, respectively, for ED mortality. Conclusion: In this study, all trauma scores performed similar in the ED for the prediction of ED mortality.Publication Open Access Grayanotoxin (Mad Honey) - Ongoing Consumption After Poisoning(AVES YAYINCILIK, 2013-09-10) DENİZBAŞI ALTINOK, ARZU; Eroglu, Serkan Emre; Urgan, Oguz; Onur, Ozge Ecmel; Denizbasi, Arzu; Akoglu, HaldunBackground: Some honey types in certain geographical regions may cause toxic effects on people. This type of honey is known as mad honey in Turkey. The toxic ingredient of this honey is called Grayanotoxin I. The consumption of mad honey can cause severe bradycardia, hypotension, dizziness, nausea and vomiting. Aims: Our study is aimed at analysing patients diagnosed with mad honey poisoning and their behaviour towards the consumption of this honey after diagnosis. Study Design: Cross sectional study. Methods: This cross-sectional study was based on complaints and findings of mad honey poisoning. Patient information and findings at the time of admission were compared with those at one month after discharge through telephone interviews. They were asked if either they or their relatives had continued consuming the same honey. Frequency data such as gender, purpose of honey consumption, first complaints and continuance of honey consumption are shown as number (n) and percentage (%). A Chi Square test was conducted to determine the difference between groups. Results: 38 patients were participated in this study; 18 of the patients had to be followed up in a coronary intensive care unit. We were able to reach 34 patients by phone after discharge. It was found that 12 of 16 patients discharged after emergency unit observation or their close relatives were continuing to consume mad honey, whereas 16 (88.9%) of the 18 patients under coronary intensive care had discontinued consuming mad honey. The difference in the continuation of mad honey consumption between patient groups followed-up in the intensive care unit and those discharged after emergency observation was statistically significant. Conclusion: Hazards associated with and serious consequences following the consumption of mad honey must be clearly explained to patients who are found to be consuming mad honey.Publication Open Access The Effects of Intravenous Lipid Emulsion Therapy in the Prevention of Depressive Effects of Propofol on Cardiovascular and Respiratory Systems: An Experimental Animal Study(MDPI, 2018-12-25) ONUR, ÖZGE ECMEL; Doganay, Fatih; Ak, Rohat; Aliskan, Halil; Abut, Serdar; Sumer, Engin; Onur, OzgeBackground and objectives: Although there are several hypotheses about the mechanism of action, intravenous lipid emulsion (ILE) therapy has been shown to be effective in the treatment of toxicities due to local anaesthetics and many lipophilic drugs. In this study, we had hypothesized that ILE therapy might also be effective in preventing mortality and cardiorespiratory depressant effects due to propofol intoxication. Materials and methods: Twenty-eight Sprague-Dawley adult rats were randomly divided into four groups. Saline was administered to the subjects in the control group. The second group was administered propofol (PP group); the third group was administered ILE (ILE group), and the fourth group was administered propofol and ILE therapy together (ILE+PP group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mortality were recorded at 10 time-points during a period of 60 min. A repeated measures linear mixed-effect model with unstructured covariance was used to compare the groups. Results: In the PP group; SBP, DBP, RR, and HR levels declined steadily; and all rats in this group died after the 60-min period. In the ILE+PP group, the initially reduced SBP, DBP, RR, and HR scores increased close to the levels observed in the control group. The SBP, DBP, RR, and HR values in the PP group were significantly lower compared to the other groups (p < 0.01). The mortality rate was 100% (with survival duration of 60 min) for the PP group; however, it was 0% for the remaining three groups. Conclusions: Our results suggest that the untoward effects of propofol including hypotension, bradycardia, and respiratory depression might be prevented with ILE therapy.